Heart Failure and Women

Heart failure affects about 2.5 million women in the United States. Despite the fact that women account for nearly 50% of all hospital admissions for heart failure, only 25% of women are involved in heart failure studies. Consequently, advances in heart failure therapies apply to most men, but have not been adequately studied in women.

Differences of women with heart failure as compared to men with heart failure:

Women tend to develop congestive heart failure at an older age than men.

Women tend to develop diastolic heart failure with a more normal ejection fraction than men. Ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart. Heart failure can occur due to a weakened heart muscle (systolic heart failure) or may be related to a stiff, inflexible heart muscle (diastolic heart failure). In some cases the ejection fraction can be normal, but due to the increased pressures inside the heart and lungs, the patient can have heart failure. Learn more

The causes of heart failure in women are often linked to high blood pressure, coronary artery disease, valvular disease, and diabetes mellitus.

Although rare, peripartum cardiomyopathy is a cause of heart failure unique to women. Peripartum cardiomyopathy is the rare development of heart failure within the last month of pregnancy, or within five months after delivery. Peripartum cardiomyopathy occurs without an identifiable cause.

Depression is frequently associated with heart failure and is more common in women than men.

Although the signs and symptoms of heart failure are the same among men and women, women tend to have more symptoms such as shortness of breath and more difficulty exercising than men. They also have swelling around their ankles more frequently than men.

Diastolic Versus Systolic Heart Failure

Women develop diastolic heart failure more often than men, and more frequently than systolic heart failure. Diastolic heart failure occurs when the heart pumps normally, but the ventricles become stiff and doesn't relax properly. This causes the pressure to rise in the heart and lungs. Systolic heart failure occurs when the heart is weak and doesn't contract with enough force. In systolic heart failure there is not enough oxygen-rich blood being pumped throughout the body. The weak heart causes blood to accumulate, leading to a rise in pressure in the heart and lungs very similar to that seen in diastolic heart failure, but due to a different mechanism (ie. weak heart instead of stiff heart).

Causes of Heart Failure Unique to Women

The causes of heart failure in women are different than in men. Women with heart failure are more likely than men to have high blood pressure valvular disease, and diabetes mellitus, and less likely to have congestive heart failure due to prior heart attacks (ischemic cardiomyopathy).

However, women can still develop atherosclerosis (progressive narrowing of the arteries). In fact, although women with congestive heart failure develop coronary artery disease less often then men the frequency is still so high that it is the second leading cause for women with heart failure. It is important to remember that women often have atypical symptoms such as shortness of breath, as compared to men whose primary symptom is often chest pain. Therefore, women like men need to be evaluated for blockages in the arteries.

Women with breast cancer who have been treated with chemotherapy including doxorubicin (Adriamycin) can also develop congestive heart failure due to the toxic effects that these drugs can have on the heart muscle (called drug toxicity).

Another cause of congestive heart failure unique to women is peripartum cardiomyopathy. Peripartum cardiomyopathy is the rare development of heart failure within the last month of pregnancy or within five months after delivery. The cause of peripartum cardiomyopathy remains unknown.

Blood Tests:

Certain blood tests can help your doctor determine the cause and severity of heart failure. Blood tests may be done to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood disorder that occurs when there is not enough red blood cells in a person's blood.

B-type Natriuretic Peptide (BNP) blood test

When heart failure occurs or worsens, the pumping chambers, or ventricles, secrete a substance called BNP (pro-B type natriuretic peptide) in response to the accompanying changes in blood pressure. The BNP level rises when heart failure symptoms worsen, and it falls when the condition is stable. BNP helps determine if you have heart failure, rather than another condition that may cause similar symptoms. It also can help the doctor determine if your heart failure has worsened and more aggressive treatments are needed.

To test the BNP level, a small amount of blood is taken and placed in a machine that detects the level of BNP in your blood. The BNP level helps determine if you have heart failure. Usually, BNP levels below 100 pg/mL indicate no heart failure and levels above 100-300 suggest heart failure is present.

The BNP level also indicates if your heart failure condition has worsened and can provide information about your prognosis.

It is a graphic outline of the heart's movement. During an echo, a wand is placed on the surface of your chest. This wand sends ultrasound waves that provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied. Echo can also find changes in the blood flow across the heart's valves and the pressure within the heart's chambers. It may also help estimate the blood pressure within the lungs.

Records the electrical impulses traveling through the heart. During the test, small, flat, sticky patches called electrodes are placed on your chest. The electrodes are attached to an electrocardiograph monitor (EKG) that charts your heart's electrical activity on graph paper.

Ejection fraction (EF)

A test that determines how well your heart pumps with each beat. A normal EF is generally 50-55%. It is important for your doctor to know your EF. Your EF can go up and down, based on your heart condition and the effectiveness of the therapies that have been prescribed. It is important to have your EF measured initially and as needed, based on changes in your condition. Ask your doctor how often you should have your EF checked.

An EF of less than 50 percent usually confirms a diagnosis of systolic heart failure (a condition that occurs when the heart muscle doesn't contract with enough force, so there is not enough oxygen-rich blood to be pumped throughout the body). Diastolic dysfunction is a condition that occurs when the heart contracts normally, but the ventricle doesn't relax properly so less blood can enter the heart. People with diastolic dysfunction can have a normal EF or a low EF.

Other tests

Test Results

Although the same tests are used to diagnose heart failure in women and men, the results may not be the same. For instance, BNP blood levels are used to help diagnose heart failure and determine severity. However, the "normal" values for women are higher than for men.

There is also some evidence to suggest that the results of a metabolic stress test (which evaluates oxygen uptake during exercise - Peak VO2) are worse for women than men. The differences in results may be related to the adjustments made to the test results. The metabolic stress test results are adjusted for body weight but are not adjusted for lean body mass. This may explain the differences in results among men and women, since women usually have a higher percentage of body fat than men.

With the right care, heart failure will not stop you from doing the things you enjoy. Your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan.

In general, women with heart failure survive longer than men with heart failure but remain symptomatic (ie. shortness of breath) and functionally more limited. Women with heart failure also require hospitalization more frequently than men.

Your health care team will help you manage your condition and help you stay on track with your heart failure treatment plan. It is important to keep regular follow-up appointments with your health care team, as well as to take your medications as prescribed, make dietary changes and live an active and healthy lifestyle.

Everyone with a chronic illness, such as heart failure, should discuss their desires for extended medical care with their doctor and family. An "advance directive" or "living will" is one way to let everyone know your wishes. A living will expresses your desires about the use of medical treatments to prolong your life. This document is prepared while you are fully competent in case you are unable to make these decisions at a later time.

References

With the right care, heart failure will not stop you from doing the things you enjoy. Your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan. In general, women survive longer than men with heart failure 1-2 but remain symptomatic (ie. shortness of breath) and functionally more limited 3-4.

Everyone with a chronic illness, such as heart failure, should discuss their desires for extended medical care with their doctor and family. An "advance directive" or "living will" is one way to let everyone know your wishes. A living will expresses your desires about the use of medical treatments to prolong your life. This document is prepared while you are fully competent in case you are unable to make these decisions at a later time. Learn More.

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